When visual disability occurs in childhood, it
challenges children's development. In working age, it lowers
productivity. Across the life span – and particularly among the
elderly – it devalues the quality of life.
The social and economic consequences are serious,
to individuals, families and communities. Yet much of this is
avoidable – either preventable or curable. The evidence is clear:
prevention of blindness is a worthwhile investment, not only in human
terms, but also in economic terms.
WHO has been dealing with causes of blindness and
care for the blind since the early years of the Organization. Trachoma
was one of the health problems in the aftermath of the Second World
War, requiring international control efforts.
During the 1950s, WHO developed an extensive field
research programme. This effort lead to the implementation of control
strategies in most endemic countries, often together with UNICEF,
during the 1960s and into the 1970s.
The achievements were impressive. We learnt the
invaluable lesson that success depended on our ability to accompany
medical intervention with an emphasis on social development. We see
the consequences even today. Trachoma is still around, but now as a
disease mainly in areas of severe poverty. I am pleased to note the
new emphasis on behavioural and environmental factors for trachoma
control in "Vision 2020". This is the way to future
successful elimination of blinding trachoma.
The effort to control trachoma was only one of
several so-called "vertical" disease campaigns conducted by
WHO. We have since learned a lot about what it takes to make a lasting
success. The concept of primary health care underscores that it takes
more than a disease control campaign to achieve lasting change. The
community must be the driving force in achieving health, in terms of
awareness, motivation, and support to health care delivery.
Today we have gained more knowledge, not only about
the major global causes of blindness, but also about the
socio-economic and other consequences of disability. The
Onchocerciasis Control Programme in West Africa started 25 years ago
with the ambitious goal of removing one of the major obstacles to
development in some of the poorest countries of the world. The link
between severe disability, in this case through blindness and poverty
was obvious.
Today we can look towards the end of onchocerciasis
as a public health problem with the recent expansion of control
programmes in Africa and Latin America.
Trachoma and onchocerciasis are diseases occurring
in particular circumstances. It was not until the late 1970s that the
main, global cause of visual disability was recognized. Cataract is
today responsible for close to 50% of global blindness.
Cataract surgery is today the most common surgical
intervention world wide. It brings relief to many, but it is also a
cause of great public health expenditure in all countries. At the same
time it is one of the most challenging problems of access to services
for all those in need. There has been progress in cataract surgery in
recent years, both in terms both of technology, cost-effectiveness and
the development of sustainable services.
Still, almost 20 million visually disabled people
world-wide could benefit from cataract surgery. This would
dramatically improve their social and economic potential, and of
course, their quality of life.
Underlying the idea of "Vision 2020" is
the value of partnership. This is a guiding principle for WHO. The
global health agenda is too big for any single actor. We need to reach
out to form new partnerships, to the UN family, to the private sector
and to civil society. WHO has official relations and work plans with
some 190 nongovernmental organizations in addition, of course, to our
191 Member States.
By working together, we can achieve what was
previously not possible for individual agencies. This is the best
message we can give to demonstrate opportunities for more action in
the field of international health.
"Vision 2020" carries a vision of a
future in which all may have a reasonable expectation to have the
"right to sight". "Vision 2020" is also a message
of equity. Vulnerable groups, such as children, women and the elderly
are given priority attention.
We need to look ahead, and focus on the major
causes of disability that are preventable or can be treated in a
cost-effective and sustainable way. "Vision 2020"
encapsulates all of this. The inclusion of causes of childhood
blindness in this global initiative is a promising development.
Vision 2020 is a concerted effort to create
an awareness of the enormity of the problem and its projected
substantial increase in the next 20 years, if nothing is done now.
